Study shows costly weight loss drug may also cut risks of heart attacks

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The nation’s obesity epidemic is growing. Nearly 42 percent of all American adults are considered obese. Now, new findings about the FDA-approved weight-loss drug Wegovy may lead to even more demand for a medication that can be both life-changing and expensive. William Brangham reports.

Geoff Bennett:

The nation's obesity epidemic is growing. Nearly 42 percent of all American adults are considered obese.

Now new findings about an FDA-approved weight loss drug may lead to even more demand for a medication that can be both life-changing and expensive.

William Brangham has the latest.

William Brangham:

Roughly 100 million Americans suffer from obesity and its many associated health risks. Obesity takes a terrible economic toll as well, costing this country an estimated $200 billion a year.

A new weight loss drug called Wegovy has shown, according to one study, that it not only can help with obesity, but it might also cut the risk of heart attacks, strokes and other heart problems by 20 percent. But there are real concerns about potential side effects.

For a closer look, we are joined by Dr. Michael Blaha. He's director of clinical research at the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease.

Dr. Blaha, very good to have you on the "NewsHour."

Before we get to talking about this drug, could you just remind us of the connections between obesity and heart disease?

Dr. Michael Blaha, Johns Hopkins Medicine:

Yes, sure.

As you said, obesity is extremely common, and it's linked with so many forms of cardiovascular disease. Obesity itself is an inflammatory condition. It raises your blood pressure. It can cause diabetes and other risk factors.

And it's linked to atherosclerosis of the arteries, which puts you at risk for heart attacks and strokes. It also raises the risk of heart failure and atrial fibrillation, a heart rhythm abnormality, too. So, really, obesity underpins many of the chronic cardiovascular conditions that we treat in a cardiology practice.

William Brangham:

OK, according to this one study — and only parts of it have been released — but it indicates that Wegovy could prevent up to 1.5 million heart attack, strokes and other events over the course of 10 years.

If that's true, with all the caveats there, how big a deal is that?

Dr. Michael Blaha:

This is a really big deal, in my opinion.

We have waited for a long time to be able to treat obesity in clinical medicine and actually lower cardiovascular events. And as a cardiologist, we haven't paid much attention to obesity, because we couldn't do anything about it and affect our outcomes.

But now, with the potential on the horizon to better treat obesity and lower cardiovascular disease, you have the attention of cardiologists and other specialists who treat cardiovascular disease. So this is a really big deal.

And I think it's finally going to change the paradigm on the way we think about obesity, the way we treat obesity. And there's a lot more to work out. And, as you mentioned, we need to see the results of the actual study.

William Brangham:

Walk me through some of the ways in which it might be a paradigm shift for your profession.

Dr. Michael Blaha:

Most of our patients don't lose weight. In fact, most of our patients gain weight over time, or, if they lose weight, they can't keep it off.

So obesity underpins so many of the chronic diseases that we treat. Obstructive sleep apnea is one. That can lead to hypertension that becomes hard to treat. Cholesterol abnormalities. Of course, diabetes. I mentioned before the myocardial infarctions, the heart attacks and the strokes, but also the heart failure, the chronic heart failure that's troubling for many of our patients, and the atrial fibrillation, which is becoming epidemic.

So it underpins so much of what we do. So we treat many of the complications of obesity in our practice right now, but we never get to the root cause. And this is it's been so frustrating over so long is, we're just treating the manifestations of obesity. It's a very costly way of doing things, compared to actually treating the underlying — underlying causes of all the problems.

William Brangham:

As I mentioned, there are some concerns about complications or side effects with these drugs. What is your understanding of those? And what do people need to know about that part of it?

Dr. Michael Blaha:

These drugs are really well-known, actually, because we have been using them in the diabetes space for over a decade.

So now we have approval to use these — some of the same medications at higher doses for weight loss, or at least one in particular. So we have learned a lot in the clinical arena about how to use these drugs. And, absolutely, there are side effects. In fact, the side effects are closely associated with their mechanism of action.

And I could briefly say that the way these medications work is they slow the emptying of food from the stomach. They signal hormonal changes that put us in that fed state, so we feel satiated and not hungry anymore. And they also work directly on the brain to reduce hunger.

So, some of the side effects are those very things, if they are beyond what a patient can tolerate. So you can get full bloating feeling in the stomach after a big meal. You can get nausea, sometimes vomiting, or diarrhea. They are largely controllable with diet changes.

So it's very important, if a patient were to consider a medication like this, that this isn't in lieu of diet and exercise. It's with diet changes.

William Brangham:

And if someone starts on these drugs, is it a they take them for a short period of time? Are they taking them for the rest of their life? What is that?

Dr. Michael Blaha:

If you stop taking these medications, patients do regain weight. At least most of them are regaining weight, maybe not all the weight, but much of the weight.

So it's really shifting the thinking about obesity towards that of a chronic disease. We take blood pressure medications for hypertension, and we expect that our blood pressure will go back if we stop them, and same with our cholesterol medications. We sort of assume that, if you stopped taking them, the cholesterol will go up.

But this hasn't really been worked out so much in the obesity space. But as we learn more about the disease and think of it as a chronic disease, it sort of makes sense then that the medications need to be there to exert their effect.

So we hopefully will learn a lot more about the maintenance phase of pharmacologic treatment for obesity over time. But, right now, it looks like you do need to stay on the drug to get the maximum benefit. Now, of course, in the meantime, we'd like our patients to have thorough diet and lifestyle changes that might help them keep the weight off.

So it's really, once again, diet, exercise and the drugs.

William Brangham:

I know you're not in the business of health insurance, per se. But there is a question as to, as these drugs show their promise, whether or not health insurance and particularly whether Medicare ought to cover them.

Is it your opinion that these do offer enough benefit that that really ought to be a consideration?

Dr. Michael Blaha:

It's my opinion, based on this trial that's been run and the size of the trial and how well it was run, that the evidence is going to be sufficient for the FDA to approve these weight loss drugs, Wegovy, in particular, for cardiovascular risk reduction.

And having that FDA approval for cardiovascular risk reduction will then open up an opportunity or at least put pressure on payers like Medicare to cover this medication more broadly. And we have been waiting for this. We have anticipated this trial as a pivotal moment to see, is this going to be drug that many people will benefit from, or is this one that we will keep this more of a niche product for maybe severe obesity?

And it looks like we're going to have broad-based cardiovascular benefits. So, absolutely, we're going to see much broader coverage, I think.

William Brangham:

All right, Dr. Michael Blaha of Johns Hopkins Medicine, thank you so much for being here.

Dr. Michael Blaha:

Yes, my pleasure. Thank you.

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William Brangham William Brangham

William Brangham is a correspondent and producer for PBS NewsHour in Washington, D.C. He joined the flagship PBS program in 2015, after spending two years with PBS NewsHour Weekend in New York City.

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